• Pregnancy: experts agreed to retain Pregnancy as a core variable.

• Definition of shock: All listed vital signs were considered important for assessing shock, and a separate shock item was added.
  • A clear and consistent definition will need to be included
• Level of consciousness: Discussion is needed on whether AVPU or GCS should be retained as the preferred assessment tool.
• Definition of obesity: Height and weight were not retained in this section. Obesity has been added under comorbidities, but its operational definition still needs to be discussed and agreed upon.

• Overall, all need to be included, and considered more important that symptoms
• Shock: Highly important. Needs to be carefully defined, needs further discussion
• Capillary refill ≥ 3 sec: Included in paediatric shock definition, and part of WHO guidelines
• Level of consciousness: discussion on whether to retain AVPU or GCS as the preferred assessment tool.
• Temperature: highlighted by one expert as an important parameter to include.
• Shock assessment: capillary refill time and SpO₂ identified as relevant markers of shock.
• Height/Weight: discussion on inclusion for BMI calculation and to define Obesity (see also comorbities).

• WHO warning signs: Should this be used as an umbrella category encompassing the symptoms and laboratory findings defined in the WHO classification?
  • Considerations include feasibility, clarity, and whether this grouping sufficiently captures the clinical information needed.
• Bleeding: Added as a separate variable.
  • Note that Severe Bleeding: Currently considered under complications and as part of the parent term Shock.
    
  • Panel discussion may clarify whether it should remain a distinct variable.

• Signs of ascites and pleural effusion: considered important, with discussion on the best way to capture these variables.
• Fever: suggested for exclusion by some experts.Non-discrimatory, Also captured by temperature
• Seizures: suggested for exclusion by some experts due to difficulty/reliability of recollection.
• WHO warning signs: could serve as an umbrella term to include persistent vomiting and abdominal pain; importance of balancing feasibility, accuracy, and clinical relevance was emphasized.
• Bleeding: discussion on whether to include as a symptom.

• Chronic liver disease, chronic cardiac disease, and chronic kidney disease:
  • Should these conditions be considered mandatory variables to capture?
    
  • Experts noted the challenges related to their definition, consistent classification, and reliable recollection by patients or caregivers.
• Immunosuppressive condition or Immunosuppressive medication:
  • Experts noted the challenges related to its strict definition.
• Obesity:
  • Experts expressed the need to capture this variable.
    
  • Requires clear and strict definition criteria.

• Obesity: discussion on inclusion; also noted the need to retain height and weight for BMI calculation in vitals.
• Prematurity: suggested for consideration in pediatric patients, though not deemed critical by all experts.
• Hypertension (HTA): recommended to be added as a comorbidity and moved out of the complications section.
• Chronic disease: noted challenges in reliable recollection by participants.
• Cancer: considered for exclusion by some experts

• Hematocrit and hemoglobin:
  • Should hematocrit be used as the primary marker for assessing anemia, given its potential advantages over hemoglobin? - Clarification is needed on whether hematocrit should be considered as a standalone criterion.
• DENV serotype: While acknowledging that serotyping is not available in all settings, it remains a valuable variable when available and can be captured rapidly.
  • The panel should consider whether its inclusion would meaningfully increase the burden on data collectors.

• DENV serotype: considered important, though acknowledged as not available in all settings.
• Hemoglobin: experts noted that hematocrit may be a better marker, being less affected by potential hemoconcentration.
• Creatinine: considered important for defining AKI.
• Availability of blood count results: suggested for exclusion by some experts.

• Severe Organ Impairment: Proposal to reclassify variables related to liver dysfunction, cardiac complications, and brain injury under the umbrella term Severe Organ Impairment.
  • Discussion is needed to clarify the boundaries of this definition and which specific conditions or indicators should be included.
• Severe Bleeding: Also considered under the parent term Shock.
  • Panel discussion needed on whether it should be retained as a separate variable.

• Severe Organ Impairment: suggested reclassification under the umbrella term Severe Organ Impairment for variables related to liver dysfunction, cardiac complications, and brain injury.
• Fluid overload: suggested reclassification under the umbrella term Fluid overload for variables such as pleural effusion and ascites.
• Seizure: suggested for exclusion by some experts.

• Fluid drainage: Experts agreed to remove this variable as it is not routinely performed in practice.
  • Discussion is needed on whether diuretics should be included instead.

Key Points From Expert Consultation

• Antivirals: suggested for exclusion by some experts.
• Fluid drainage (Therapeutic ascitic/pleural tap included): There was discussion the need to keep as not done in every settings. Use of Diuretic was also mentioned.
• NSAIDs: In addition to NSAIDs, Paracetamol was mentioned as a possible cause of liver dysfunction

• Pregnancy: experts agreed to retain Pregnancy as a core variable.

• Definition of shock: All listed vital signs were considered important for assessing shock, and a separate shock item was added.
  • A clear and consistent definition will need to be included
• Level of consciousness: Discussion is needed on whether AVPU or GCS should be retained as the preferred assessment tool.
• Definition of obesity: Height and weight were not retained in this section. Obesity has been added under comorbidities, but its operational definition still needs to be discussed and agreed upon.

• Overall, all need to be included, and considered more important that symptoms
• Shock: Highly important. Needs to be carefully defined, needs further discussion
• Capillary refill ≥ 3 sec: Included in paediatric shock definition, and part of WHO guidelines
• Level of consciousness: discussion on whether to retain AVPU or GCS as the preferred assessment tool.
• Temperature: highlighted by one expert as an important parameter to include.
• Shock assessment: capillary refill time and SpO₂ identified as relevant markers of shock.
• Height/Weight: discussion on inclusion for BMI calculation and to define Obesity (see also comorbities).

• WHO warning signs: Should this be used as an umbrella category encompassing the symptoms and laboratory findings defined in the WHO classification?
  • Considerations include feasibility, clarity, and whether this grouping sufficiently captures the clinical information needed.
• Bleeding: Added as a separate variable.
  • Note that Severe Bleeding: Currently considered under complications and as part of the parent term Shock.
    
  • Panel discussion may clarify whether it should remain a distinct variable.

• Signs of ascites and pleural effusion: considered important, with discussion on the best way to capture these variables.
• Fever: suggested for exclusion by some experts.Non-discrimatory, Also captured by temperature
• Seizures: suggested for exclusion by some experts due to difficulty/reliability of recollection.
• WHO warning signs: could serve as an umbrella term to include persistent vomiting and abdominal pain; importance of balancing feasibility, accuracy, and clinical relevance was emphasized.
• Bleeding: discussion on whether to include as a symptom.

• Chronic liver disease, chronic cardiac disease, and chronic kidney disease:
  • Should these conditions be considered mandatory variables to capture?
    
  • Experts noted the challenges related to their definition, consistent classification, and reliable recollection by patients or caregivers.
• Immunosuppressive condition or Immunosuppressive medication:
  • Experts noted the challenges related to its strict definition.
• Obesity:
  • Experts expressed the need to capture this variable.
    
  • Requires clear and strict definition criteria.

• Obesity: discussion on inclusion; also noted the need to retain height and weight for BMI calculation in vitals.
• Prematurity: suggested for consideration in pediatric patients, though not deemed critical by all experts.
• Hypertension (HTA): recommended to be added as a comorbidity and moved out of the complications section.
• Chronic disease: noted challenges in reliable recollection by participants.
• Cancer: considered for exclusion by some experts

• Hematocrit and hemoglobin:
  • Should hematocrit be used as the primary marker for assessing anemia, given its potential advantages over hemoglobin? - Clarification is needed on whether hematocrit should be considered as a standalone criterion.
• DENV serotype: While acknowledging that serotyping is not available in all settings, it remains a valuable variable when available and can be captured rapidly.
  • The panel should consider whether its inclusion would meaningfully increase the burden on data collectors.

• DENV serotype: considered important, though acknowledged as not available in all settings.
• Hemoglobin: experts noted that hematocrit may be a better marker, being less affected by potential hemoconcentration.
• Creatinine: considered important for defining AKI.
• Availability of blood count results: suggested for exclusion by some experts.

• Severe Organ Impairment: Proposal to reclassify variables related to liver dysfunction, cardiac complications, and brain injury under the umbrella term Severe Organ Impairment.
  • Discussion is needed to clarify the boundaries of this definition and which specific conditions or indicators should be included.
• Severe Bleeding: Also considered under the parent term Shock.
  • Panel discussion needed on whether it should be retained as a separate variable.

• Severe Organ Impairment: suggested reclassification under the umbrella term Severe Organ Impairment for variables related to liver dysfunction, cardiac complications, and brain injury.
• Fluid overload: suggested reclassification under the umbrella term Fluid overload for variables such as pleural effusion and ascites.
• Seizure: suggested for exclusion by some experts.

• Fluid drainage: Experts agreed to remove this variable as it is not routinely performed in practice.
  • Discussion is needed on whether diuretics should be included instead.

Key Points From Expert Consultation

• Antivirals: suggested for exclusion by some experts.
• Fluid drainage (Therapeutic ascitic/pleural tap included): There was discussion the need to keep as not done in every settings. Use of Diuretic was also mentioned.
• NSAIDs: In addition to NSAIDs, Paracetamol was mentioned as a possible cause of liver dysfunction